Endoluminal Access Device

ABSTRACT

A surgical access apparatus for providing access inside a body includes a housing having a first port, a tubular member extending distally from the housing and defining a longitudinal axis therealong, wherein the tubular member includes a lumen extending therethrough. a shaft insert disposed in the lumen of the tubular member, wherein the shaft insert forms first, second, and third passageways extending along the lumen of the tubular member, wherein each of the first, second, and third passageways is adapted to receive a surgical instrument; and a first seal assembly covering the first port of the housing and defining a first passage disposed in communication with the first passageway defined by the shaft insert in the tubular member, wherein the first seal assembly is adapted to form a seal around the surgical instrument inserted through the first passage of the first seal assembly.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a Continuation Application claiming thebenefit of and priority to U.S. patent application Ser. No. 12/358,684,filed on Jan. 23, 2009, which claims the benefit of and priority to U.S.Provisional Patent Application 61/023,644, filed on Jan. 25, 2008, theentire contents of each of which being incorporated herein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical instruments and methods. Moreparticularly, the present disclosure relates to an endoluminal accessdevice.

2. Background of Related Art

Endoluminal surgery encompasses all surgical procedures that involveintentional instrument penetration into a lumen of a human body, such asvascular lumens, gastrointestinal lumens, or air exchange lumens. Forexample, endoluminal surgery may be performed by introducing a surgicalinstrument through the esophagus, rectum, vagina, urethra or bladder.These procedures generally entail diagnosis or treatment of diseases ordebilitating conditions. Surgeons usually utilize a rigid or flexibletube, such as an endoscope, during endoluminal surgery. The tube isnormally introduced into the human body through a body orifice, such asthe mouth or rectum, or through an incision. Endoscopes allow surgeonsto view the target surgical site and may provide one or more workingchannels, or pathways, to the treatment site. During endoluminalsurgical procedures, the surgeon steers or places the endoscope throughthe body until it reaches the intended site. Thereafter, the surgeon mayperform the appropriate medical procedure.

SUMMARY

A surgical access apparatus for providing access inside a body includesa housing having a first port, a tubular member extending distally fromthe housing and defining a longitudinal axis therealong, wherein thetubular member includes a lumen extending therethrough. a shaft insertdisposed in the lumen of the tubular member, wherein the shaft insertforms first, second, and third passageways extending along the lumen ofthe tubular member, wherein each of the first, second, and thirdpassageways is adapted to receive a surgical instrument; and a firstseal assembly covering the first port of the housing and defining afirst passage disposed in communication with the first passagewaydefined by the shaft insert in the tubular member, wherein the firstseal assembly is adapted to form a seal around the surgical instrumentinserted through the first passage of the first seal assembly.

In one embodiment, the tubular member is made of a one of rigid materialand a flexible material.

In one embodiment, the housing includes a first tubular portion definingan axis that is at an oblique angle relative to the longitudinal axis ofthe tubular member.

In one embodiment, the first tubular portion of the housing includes abore disposed in fluid communication with the first port.

In one embodiment, the housing includes a second port and a third port,each of the second and third ports being adapted to receive a surgicalinstrument.

In one embodiment, wherein the housing includes a second tubular portionhaving a bore, the bore being disposed in communication with the secondport and the second passageway.

In one embodiment, the second tubular portion of the housing defines anaxis that is oriented substantially parallel to the longitudinal axis ofthe tubular member.

In one embodiment, the access apparatus further includes a second sealassembly releasably connected to the second tubular portion of thehousing, the second seal assembly having passage disposed incommunication with the second passageway, wherein the seal assembly isadapted to form a seal around a surgical instrument inserted through thesecond passage.

In one embodiment the second passageway is configured to receive anobturator in the absence of the second seal assembly.

In one embodiment, the housing includes a third tubular portion having abore, the bore being disposed in communication with the third port andthe third passageway.

In one embodiment, the third tubular portion of the housing defines anaxis that is at an oblique angle relative to the longitudinal axis ofthe tubular member.

In one embodiment, the third passageway is configured to receive anendoscope.

The present application further relates to another embodiment of asurgical access apparatus for providing access inside a body. Thisembodiment includes a housing having a first port, a tubular memberextending distally from the housing and defining a longitudinal axistherealong, wherein the tubular member includes a lumen extendingtherethrough, a dividing wall positioned along the lumen of the tubularmember, the dividing wall having a substantially S-shaped transversecross-sectional profile, wherein the substantially dividing wall dividesthe lumen into first and second passageways, wherein each of the firstand second passageways is adapted to receive a surgical instrument, anda first seal assembly covering the first port of the housing anddefining a first passage disposed in communication with the firstpassageway defined by the shaft insert in the tubular member, whereinthe first seal assembly is adapted to form a seal around the surgicalinstrument inserted through the first passage of the first sealassembly.

In one embodiment, the tubular member is made of a one of rigid materialand a flexible material.

In one embodiment, the housing includes a first tubular portion definingan axis that is at an oblique angle relative to the longitudinal axis ofthe tubular member.

In one embodiment, the first tubular portion of the housing includes abore disposed in fluid communication with the first port.

In one embodiment, the housing includes a second port and a third port,each of the second and third ports being adapted to receive a surgicalinstrument.

In one embodiment, the housing includes a second tubular portion havinga bore, the bore being disposed in communication with the second portand the second passageway.

In one embodiment, the second tubular portion of the housing defines anaxis that is oriented substantially parallel to the longitudinal axis ofthe tubular member.

In one embodiment, the dividing wall is made of at least one of aflexible and resilient material.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the presently disclosed access device are describedherein with reference to the accompanying drawings, wherein:

FIG. 1 is a perspective view of an access apparatus according to anembodiment of the present disclosure;

FIG. 2 is a perspective view of a proximal portion of the accessapparatus shown in FIG. 1;

FIG. 3 is a top view of the access apparatus shown in FIG. 1;

FIG. 4 is a side view of the access apparatus shown in FIG. 1;

FIG. 5 is a perspective view, with parts separated, of the accessapparatus shown in FIG. 1;

FIG. 6 is a side cross-sectional view of the access apparatus shown inFIG. 1, taken along section line 6-6 of FIG. 3;

FIG. 7 is an enlarged view of the indicated area of detail of FIG. 6;

FIG. 8 is a top cross-sectional view of the access apparatus shown inFIG. 1, taken along section line 8-8 of FIG. 4;

FIG. 9 is an enlarged view of the indicated area of detail of FIG. 8;

FIG. 10 is a front view of the access apparatus shown in FIG. 1;

FIG. 11 is a perspective cross-sectional view of the access apparatusshown in FIG. 1, taken along section line 11-11 of FIG. 3;

FIG. 12 is a perspective cross-sectional view of the access apparatusshown in FIG. 1, taken along section line 12-12 of FIG. 3;

FIG. 13 is a front cross-sectional view of the access apparatus shown inFIG. 1, taken along section line 13-13 of FIG. 4;

FIG. 14 is a perspective view of an obturator, and the access apparatusshown in FIG. 1 with a seal assembly detached therefrom;

FIG. 15 is a perspective view of the access apparatus shown in FIG. 1with the obturator depicted in FIG. 14 inserted therein;

FIG. 16 is a side cross-sectional view of the access apparatus andobturator shown in FIG. 15, taken along section line 16-16 of FIG. 15;

FIG. 17 is an enlarged view of the indicated area of detail of FIG. 16;

FIG. 18 is a perspective view showing the proximal and distal portionsof the obturator depicted in FIG. 14;

FIG. 19 is a perspective view of a distal portion of the accessapparatus shown in FIG. 1 without the obturator being introduced in theaccess apparatus;

FIG. 20 is a perspective view of the distal portion of the accessapparatus shown in FIG. 1 with the obturator inserted into the accessapparatus;

FIG. 21 is a perspective view of an access apparatus with a flexibleshaft according to another embodiment of the present disclosure;

FIG. 22 is a perspective view of the access apparatus depicted in FIG.21 showing the flexible shaft bent relative to the longitudinal axisB-B;

FIG. 23 is a top view of the access apparatus depicted in FIG. 21;

FIG. 24 is a perspective view, with parts separated, of the accessapparatus depicted in FIG. 21;

FIG. 25 is an enlarged view of the indicated area of detail of FIG. 24;

FIG. 26 is a side cross-sectional view of the access apparatus depictedin FIG. 21, taken along section line 26-26 of FIG. 21;

FIG. 27 is an enlarged view of the indicated area of detail of FIG. 26;

FIG. 28 is a front cross-sectional view of the access apparatus depictedin FIG. 21, taken along section line 28-28 of FIG. 23;

FIG. 29 is a perspective cross-sectional view of the access apparatusdepicted in FIG. 21, taken along section line 29-29 of FIG. 23;

FIG. 30 is a front cross-sectional view of the access apparatus depictedin FIG. 21, taken along section line 30-30 of FIG. 23; and

FIG. 31 is a perspective cross-sectional view of the access apparatusdepicted in FIG. 21, taken along section line 31-31 of FIG. 23.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Embodiments of the presently disclosed access apparatus will now bedescribed in detail with reference to the drawings wherein likereference numerals identify similar or identical elements. In thedrawings and in the description which follows, the term “proximal,” asis traditional, will refer to the end of the access apparatus that isclosest to the operator, while the term “distal” will refer to the endof the access apparatus that is farthest from the operator. In thepresent disclosure, the words “a,” “an,” or “the” are to be taken toinclude both the singular and the plural. Similarly, any reference toplural items shall, where appropriate, include the singular.

The present disclosure relates to an endoluminal access apparatus foruse in surgical procedures. The access apparatus provides access to aworking space inside a human body. Physicians can utilize the presentlydisclosed access device in many kinds of surgical procedures including,but not limited to, endoluminal, transvaginal, endoscopic andlaparoscopic procedures. In addition, the access apparatus of thepresent disclosure can be employed in combination with any suitablesurgical instrument.

Referring initially to FIGS. 1-4, an access apparatus is generallydesignated with reference numeral 100. Access apparatus 100 includes ahousing 102 and a shaft or tubular member 104. In one embodiment,tubular member 104 is made of a rigid material. Tubular member 104extends distally from housing 102 and defines a longitudinal axis A-Atherealong. Housing 102 includes a first tubular portion 118, a secondtubular portion 120, and a third tubular portion 122. Second tubularportion 120 is oriented substantially parallel to longitudinal axis A-A,whereas first and third tubular portions 118, 122 each define an axisthat is at an oblique angle relative to longitudinal axis A-A. First andthird tubular portions 118, 122 converge into second tubular portion 120of housing 102.

First tubular portion 118 of housing 102 defines a first port 106adapted to receive a surgical instrument. Second tubular portion 120defines a second port 108 configured to receive a surgical instrument.Third tubular portion 122 defines a third port 110 adapted to receive asurgical instrument. Each of the first port 106, second port 108, andthird port 110 provides a passage into an inner portion of housing 102.

Housing 102 further includes first, second, and third seal assemblies112, 114, 116, respectively. Each of the first, second and third sealassemblies 112, 114, 116 covers first port 106, second port 108, andthird port 110, respectively. As will be discussed in detail below,first, second, and third seal assemblies 112, 114, 116 form a sealaround a surgical instrument when said surgical instrument is insertedthrough first, second, and third ports 106, 108, 110, respectively.Also, second and third seal assemblies 114, 116 are configured to remainclosed in the absence of a surgical instrument extending therethrough.

In addition to seal assemblies 112, 114, 116, housing 102 includes aninsufflation assembly 124 configured to be connected to a source ofinsufflation gases or a vacuum system (not shown). Insufflation assembly124 incorporates an insufflation port 128 and a stop-cock valve 126.Insufflation port 128 defines a lumen 130 disposed in fluidcommunication with an inner portion of housing 102 and includes anexternal thread 132 for facilitating connection to a source ofinsufflation gases or a vacuum system.

Stopcock valve 126 has an open position and a closed position. Thus,stopcock valve 126 is capable of controlling fluid flow throughinsufflation assembly 124. In the open position, stopcock valve 126allows fluid flow through insufflation assembly 124. In the closedposition, stopcock valve 126 prevents or hinders fluid flow throughinsufflation assembly 124. In one embodiment, stopcock valve 126includes a lever 134 extending therefrom. Lever 134 facilitates rotationof stopcock valve 126 with respect to housing 202. In use, a useractuates stopcock valve 126 between the open and closed positions byrotating stopcock valve 126 relative to housing 102 through lever 134.While a stopcock valve is shown and described, it is envisioned that anysuitable valve capable of permitting and restricting fluid flow, may beprovided in insufflation assembly 124.

With reference to FIGS. 5-9, housing 102 defines an opening 136configured to receive a portion of insufflation assembly 124. Opening136 is disposed in fluid communication with insufflation port 128 andallows fluid flow between a source of insufflation gases or a vacuumsystem and an inner portion of housing 102 when insufflation port 128 isfluidly coupled to the source of insufflation gases or vacuum system. Inthe depicted embodiment, opening 136 is positioned on second tubularportion 120 of housing 102. It is contemplated that opening 136 cannevertheless be located on any part of housing 102.

As seen in FIGS. 5-9, first seal assembly 112 is fixed to first tubularportion 118 of housing 102. First seal assembly 112 includes a cover180, an instrument seal 182, a knob 184, a seal cover 186, and aduckbill valve 188. Cover 180 defines an opening 192 extendingtherethrough. Opening 192 is dimensioned to receive a surgicalinstrument and leads to an inner cavity 194 (see FIG. 9) of cover 180Inner cavity 194 is configured to receive instrument seal 182.Instrument seal 182 defines an aperture 196 extending therethrough.Aperture 196 is dimensioned to receive a surgical instrument. Inoperation, instrument seal 182 forms a fluid-tight seal around asurgical instrument when the surgical instrument is inserted throughaperture 196.

First seal assembly 114 can be connected to port 106 by snapping knob184 s onto port 106. It is envisioned, however, that first seal assembly112 may be connected to port 106 by any suitable means. When first sealassembly 112 is assembled, instrument seal 182 is located between cover180 and knob 184. As seen in FIG. 9, cover 180 includes a ring 198protruding distally therefrom. Ring 198 presses instrument seal 182against a proximal wall 200 of knob 184. Knob 184 includes a ring 202protruding proximally therefrom. Ring 202 is adapted to be receivedinside an annular space 204 formed in cover 180. During assembly, ring202 is positioned inside annular space 204 to facilitate interconnectionbetween cover 180 and knob 184.

Knob 184 further includes a longitudinal opening 206 configured toreceive a surgical instrument and at least a portion of seal cover 186.Seal cover 186 includes a hole 208 adapted to receive a surgicalinstrument and, during operation, aids in securing duckbill valve 188 tofirst seal assembly 112 and first tubular member 118. Duckbill valve 188is partially disposed in a bore 210 of first tubular portion 118. Inoperation, duckbill valve 188 forms a fluid-tight seal around a surgicalinstrument inserted therethough and closes in the absence of a surgicalinstrument extending therethrough.

As discussed above, duckbill valve 188 is positioned in bore 210 offirst tubular portion 118. Bore 210 extends through first tubularportion 118 and is dimensioned to receive not only duckbill valve 188but also a surgical instrument and a lead-in insert 190. During use,lead-in insert 190 guides the insertion of a surgical instrument throughfirst tubular portion 118. Lead-in insert 190 is in the form of aC-shaped channel and defines a passage 212 therealong. Passage 212 isdimensioned to slidably receive a surgical instrument such as anendoscope. During use, passage 212 of lead-in insert 190 steers asurgical instrument inserted through first tubular portions 118 towardsecond tubular portion 120 of housing 202.

As seen in FIGS. 5-9, second tubular portion 120 of housing 102 hasinner surfaces 140 forming a bore 138. Bore 138 extends through secondtubular portion 120 and is dimensioned to receive a portion of tubularmember 104 and a portion of first seal assembly 114. Second tubularportion 120 additionally includes an inner thread 144 formed about aproximal end 142 of inner surfaces 140 Inner thread 144 is adapted tothreadedly engage a portion of second seal assembly 114.

Second seal assembly 114 covers second port 108 and includes a cover 146defining an opening 148. Opening 148 extends through cover 146 and isdimensioned to receive a surgical instrument. Moreover, opening 148leads to an inner cavity 150, as seen in FIG. 7, defined in cover 146Inner cavity 150 of cover 146 is configured to receive an instrumentseal 152.

Instrument seal 152 defines an aperture 154 dimensioned to receive asurgical instrument. In use, instrument seal 152 forms a fluid-tightseal around a surgical instrument inserted through aperture 154. Whensecond seal assembly 114 is assembled, instrument seal 152 is positionedbetween cover 146 and knob 156. Cover 146 includes a ring 158 protrudingdistally therefrom, as seen in FIG. 7. Ring 158 presses instrument seal152 against a proximal wall 160 of knob 156, thereby securing instrumentseal 152 between cover 146 and knob 156. Knob 156 includes a ring 162protruding proximally therefrom. Ring 162 is adapted to be receivedwithin an annular space 164 formed in cover 146. During assembly, ring162 is placed within annular space 164 to facilitate interconnectionbetween cover 146 and knob 156.

Knob 156 further includes a longitudinal opening 166 configured toreceive a surgical instrument and at least a portion of a seal cover168. Seal cover 168 includes a hole 170 adapted to receive a surgicalinstrument and, during use, helps secure a duckbill valve 172 withinsecond seal assembly 114. Duckbill valve 172 is disposed between sealcover 168 and a threaded adapter 174. Duckbill valve 172 is adapted toform a fluid-tight seal around a surgical instrument insertedtherethrough and close in the absence of a surgical instrument extendingtherethrough. A portion of duckbill 175 is located inside threadedadapter 174.

With continued reference to FIGS. 5-9, threaded adapter 174 releasablysecures second seal assembly 114 to second tubular portion 120 ofhousing 102. Threaded adapter 174 includes an external thread 178 formedthereabout and a longitudinal bore 176 adapted to receive a surgicalinstrument and at least a portion of duckbill seal 175. External thread178 is configured to threadedly engage inner thread 144 of secondtubular portion 120. In operation, the user can release or attach secondseal assembly 113 to second tubular portion 120 by inserting at least aportion of threaded adapter 174 in bore 138 of second tubular portion120 and then rotating second seal assembly 114, via knob 156, withrespect to second tubular portion 120. While second seal assembly 114rotates relative to second tubular portion 120, external thread 178engages or disengages inner thread 144. When external thread 178 engagesinner thread 144, second seal assembly 114 is connected to secondtubular portion 120. Conversely, second seal assembly 114 detaches fromsecond tubular portion 120 when external thread 178 disengages frominner thread 144 of second tubular portion 120 of housing 202.

As seen in FIG. 9, third tubular portion 122 of housing 202 defines abore 214 dimensioned to receive a surgical instrument. Bore 214 isdisposed in fluid communication with third port 110. Third seal assembly116 covers third port 110 and includes a cap 216, an instrument seal218, and a duckbill valve 220. Cap 216 has a hole 222 extendingtherethrough. Hole 222 is dimensioned to receive a surgical instrumentand leads to bore 214 of third tubular portion 122. Instrument seal 218is secured between cap 216 and duckbill valve 220 and defines an opening224. Opening 224 is configured to receive a surgical instrument. In use,instrument seal 218 forms a fluid-tight seal around a surgicalinstrument inserted through opening 224. Duckbill valve 220 is adaptedto form a fluid-tight seal around a surgical instrument insertedtherethrough and close in the absence of a surgical instrument extendingtherethrough.

As seen in FIG. 9, access apparatus 100 further includes a compressionring 226 adapted to be disposed in a distal end 228 of bore 138 ofsecond tubular portion 120. When access apparatus 100 is assembled,compression ring 226 is positioned between housing 102 and tubularmember 104. Compression ring 226 compresses tubular member 104 inwardly,thus securing tubular member 104 to housing 104.

As seen in FIG. 5-9, tubular member 104 has a proximal portion 230 and adistal portion 232 Moreover, tubular member 104 includes a proximalopening 236, a distal opening 238 and a lumen 234 extendingtherethrough. Lumen 234 fluidly couples proximal and distal openings236, 238. Proximal portion 230 of tubular member 104 is disposed withinbore 138 of second tubular portion 120 of housing 202. Proximal portion230 of tubular member 104 includes an aperture 240 for establishingfluid communication between bore 210 of first tubular portion 118 andlumen 234 of tubular member 104, an opening 242 for establishing fluidcommunication between insufflation assembly 124 and lumen 234, and ahole 244 (see FIG. 9) for establishing fluid communication between bore214 of third tubular portion 122 and lumen 234. When proximal portion230 of tubular member 104 is positioned within housing 102, aperture 240is aligned with bore 210 of first tubular portion 118, opening 242 isaligned with hole 136 of second tubular portion 120, and hole 244 isaligned with bore 214 of third tubular portion 122.

As seen in FIGS. 5-9, access apparatus 100 further includes a shaftinsert 246 adapted to be disposed in lumen 234 of tubular member 104.Shaft insert 246 includes a proximal insertion member 248, a middleinsertion member 250, and a distal insertion member 252. Proximal,middle, and distal insertion members 248, 250, 252 are interconnected.Each of the proximal, middle, and distal insertion members 248, 250, 252is adapted to be inserted inside lumen 234 of tubular member 104.

Proximal insertion member 248 includes a hole 254 for facilitating fluidcommunication between insufflation assembly 124 and lumen 234 of tubularmember 104. As seen in FIG. 7, when proximal insertion member 248 islocated inside tubular member 104 and housing 102, hole 254 is alignedwith opening 242 of tubular member 104 and hole 136 of housing 102.Proximal insertion member 248 defines a channel 256 configured toslidably receive a surgical instrument therethrough. Channel 256 has alongitudinal portion 258 and a curved portion 260. As seen in FIG. 12,curved portion 260 is located at a proximal section of channel 256 andleads to bore 210 of first tubular portion 118 when shaft insert 246 isdisposed in lumen 234 of tubular member 104.

As seen in FIGS. 5 and 6, middle insertion member 250 is disposedbetween proximal insertion member 248 and distal insertion member 252and defines a longitudinal channel 262. Longitudinal channel 262 extendsalong the length of middle insertion member 250. When shaft insert 246and tubular member 104 are positioned in housing 102, longitudinalchannel 262 is longitudinally aligned with longitudinal portion 258 ofchannel 256 of proximal insertion member 248.

As seen in FIGS. 5 and 8, distal insertion member 252 also has alongitudinal channel 264 extending therealong. Longitudinal channel 264aligns with longitudinal channel 262 of middle insertion member 250 whenshaft insert 246 and tubular member 104 are connected to housing 102. Asseen in FIG. 10, longitudinal channel 264, longitudinal channel 262, andchannel 256 together form a passageway 276 disposed in communicationwith bore 210 of first tubular portion 118 of housing 102. Distalinsertion member 252 further includes an atraumatic blunt tip 266 at adistal end 268 thereof. Atraumatic blunt tip 266 prevents or minimizesdamage to a patient when access apparatus 100 is inserted into thepatient's body.

With reference to FIGS. 8-13, proximal insertion member 248 includes agroove 270 extending along a lateral portion thereof. As seen in FIG. 9,groove 270 is disposed in communication with bore 214 of third tubularportion 122 when tubular member 102 is coupled to housing 102. Middleinsertion member 250 also includes a groove 272 positioned laterallytherealong. When middle insertion member 250 is connected to proximalinsertion member 248, groove 272 of middle insertion member 250 islongitudinally aligned with groove 270 of proximal insertion member 248.Distal insertion member 252 defines a groove 274 extending along alateral portion thereof. When distal insertion member 252 is coupled tomiddle insertion member 250, groove 274 of distal insertion member 252is longitudinally aligned with groove 272 of middle insertion member250. As seen in FIG. 10, grooves 270, 272, 274 together form apassageway 278 adapted to slidably receive a surgical instrument. In oneembodiment, the cross-sectional area of the passageway 278 formed bygrooves 270, 272, 274 is smaller than the cross-sectional area of thepassageway 276 formed by longitudinal channel 264, longitudinal channel262, and channel 256, as seen in Figure. 10.

When shaft insert 246 is inserted into lumen 234 of tubular member 104,shaft insert 246 partitions lumen in three passageways 276, 278, 280.(See FIGS. 10 and 13). As discussed above, passageway 276 is connectedto bore 270 of first tubular portion 118. Passageway 278 is disposed incommunication with bore 214 of third tubular portion 122. Passageway 280is disposed in communication with bore 138 of second tubular portion120. In some embodiments, the cross-sectional area of passageway 280 islarger than the cross-sectional areas of passageways 276, 278.

With reference to FIG. 14-20, passageway 280 is configured toaccommodate at least a portion of an obturator 300. Obturator 300 has aproximal portion 302 and a distal portion 304 and incorporates a handle306, an atraumatic blunt tip 308, and a shaft 310. Handle 306 isconnected to a proximal end of shaft 310 of obturator 300 andfacilitates grasping by a user. Atraumatic blunt tip 308 is connected toa distal end of shaft 310 and aids in the insertion of access apparatus100 inside a human body while preventing or minimizing damage to thebody. In one embodiment, a transverse cross-section of atraumatic blunttip 308 is substantially similar in profile to a cross-section ofpassageway 280. In some embodiments, atraumatic blunt tip 308 has asubstantially arcuate transverse cross-section.

Obturator 300 can be inserted inside access apparatus 100 through bore138 of second tubular portion 120 once the user has removed second sealassembly 114 from housing 102. To detach second seal assembly 114 fromhousing 102, the user rotates knob 156 of second seal assembly 114relative to housing 102. As second seal assembly 114 rotates withrespect to housing 102, inner thread 175 of second seal assemblydisengages inner thread 144 of housing 102, releasing second sealassembly 114 from housing 104. As seen in FIG. 15, after detachingsecond seal assembly 114 from housing 102, the user introduces obturator300 into access apparatus 100 through bore 138 until atraumatic blunttip 308 extends beyond distal portion 232 of tubular member 104. Asshown in FIGS. 16 and 17, when obturator 300 is inserted inside accessapparatus 100, shaft 310 and a portion of atraumatic blunt tip 308 aredisposed in passageway 280. As shown in FIG. 19, before obturator 300 ispositioned within access apparatus 100, passageway 280 has a distal openend. However, as depicted in FIG. 20, once obturator 300 is positionedinside access apparatus 100, the distal end of passageway 280 is blockedby atraumatic blunt tip 308.

In operation, a user may use access apparatus 100 in conjunction withobturator 300 for a number of surgical procedures. For example, duringone surgical procedure, the user may detach second seal assembly 114from housing 102, as described above, and the user may then placeobturator 300 inside access apparatus 300, as described above. The usermay then introduce a tubular member 104 inside a patient's body via abody lumen such as the rectum or the vagina, and the user may then pushaccess apparatus 100 distally until distal portion 232 of tubular member104 has reached the target surgical site. Once tubular member reachesthe target site, the user may then remove obturator 300 from accessapparatus and reattach second seal assembly 114 to housing 102. The userreattaches second seal assembly 114 to housing 102 in the mannerdescribed above.

Subsequently, the user may connect access apparatus 100 to a source ofinsufflation gases via insufflation assembly 124. After fluidly couplingaccess apparatus 100 to a source of insufflation gases, the user mayretract body tissue at the target surgical site by insufflating the bodycavity with CO₂ or any other suitable insufflation gas. Before supplyingthe target site with insufflation gases, the user moves stop-cock valve126 to the open position to allow fluid flow through insufflationassembly 124. Following the retraction of body tissue, the userdisconnects the source of insufflation gases from insufflation assembly124.

The user may then insert an endoscope (not shown) through first port 106and slides the endoscope through passageway 276 until it reaches distalportion 232 of tubular member 104. The endoscope gives the user thecapability of observing the target site. While monitoring the targetsite with the endoscope, the user can also insert one or more surgicalinstruments through first and/or third ports 106, 110 to simultaneouslyperform one or more surgical procedures through the same body opening.

With reference to FIGS. 21-23, an alternate embodiment of accessapparatus is designated with reference numeral 1000. Access apparatus1000 includes a housing 1002 and a tubular member 1004 extendingdistally from housing 1002. In this embodiment, tubular member 1004 ismade of a flexible material. Tubular member 1004 defines a longitudinalaxis B-B when oriented in a straight position, as seen in FIG. 21.Tubular member 1004 is capable of bending with respect to longitudinalaxis B-B. (See FIG. 22). The structure and operation of housing 1002 issubstantially similar to housing 102 of access apparatus 100.

Housing 1002 includes a first tubular portion 1018, a second tubularportion 1020, and a third tubular portion 1022. First tubular portion1018 is oriented substantially parallel to longitudinal axis B-B. Secondand third tubular portions 1020, 1022 converge into first tubularportion 1018 and each is define an axis that is at an oblique anglerelative to longitudinal axis B-B.

First tubular portion 1018 includes a first port 1006 adapted to receivea surgical instrument and at least a portion of a first seal assembly1012. Second tubular portion 1020 includes a second port 1008 adapted toreceive a surgical instrument and at least a portion of a second sealassembly 1014. Third tubular portion 1022 includes a third port 1010adapted to receive a surgical instrument and at least a portion of athird seal assembly 1016. First, second, and third seal assemblies 1012,1014, 1016 form a fluid-tight seal around a surgical instrument whensaid surgical instrument is inserted through first, second, and thirdports 1006, 1008, 1010, respectively.

Housing 1002 further includes an insufflation assembly 1024 configuredto be connected to a source of insufflation gases or a vacuum system(not shown). Insufflation assembly 1024 includes an insufflation port1028 and a stop-cock valve 1026. Insufflation port 1028 defines a lumen1030 (see FIG. 30) disposed in fluid communication with an inner portionof housing 1002 and includes an external thread 1032 for facilitatingconnection to a source of insufflation gases or a vacuum system.

Stopcock valve 1026 has an open position and closed position and istherefore capable of controlling fluid flow through insufflationassembly 1024. In the open position, stopcock valve 1026 allows fluidflow through insufflation assembly 1024. In the closed position,stopcock valve 1026 prevents or hinders fluid flow through insufflationassembly 1024. In one embodiment, stopcock valve 1026 includes a lever1034 extending therefrom. Lever 1034 facilitates rotation of stopcockvalve 1026 with respect to housing 202 between the open and closedpositions. In the depicted embodiment, insufflation assembly 1024 ispositioned on first tubular member 1018. In use, a user actuatesstopcock valve 1026 between the open and closed positions by rotatingstopcock valve 1026 relative housing 1002 through lever 1034.

With reference to FIGS. 24-31, first tubular member 1018 has an opening1036 configured to receive a portion of insufflation assembly 1024.Opening 1036 is disposed in fluid communication with insufflation port1028 and a bore 1210 defined through first tubular member 1018. Inoperation, Opening 1036 permits fluid exchange between bore 1028 and asource of insufflation gases or vacuum system fluidly coupled toinsufflation assembly 1024.

As seen in FIGS. 24, 26, and 29, first tubular portion 1018 furtherincludes a plurality of ribs 1282 disposed around bore 1210. Ribs 1282facilitate the insertion of a surgical instrument through bore 1210.Bore 1210 is configured to accommodate at least a portion of first sealassembly 1012.

As seen in FIGS. 24 and 26, first seal assembly 1012 is fixed to firsttubular member 1018. First seal assembly 1012 includes a cover 1080, aninstrument seal 1082, a knob 1084, a seal cover 1086, and a duckbillvalve 1088. Cover 1080 defines an opening 1092 extending therethrough.Opening 1092 is dimensioned to receive a surgical instrument and leadsto an inner cavity 1094 (see FIG. 26) of cover 1080 Inner cavity 1094 isconfigured to receive instrument seal 1082. Instrument seal 1082 definesan aperture 1096 extending therethrough. Aperture 1096 is dimensioned toreceive a surgical instrument. In use, instrument seal 1082 forms afluid-tight seal around a surgical instrument inserted through aperture1096.

First seal assembly 1012 can be connected to port 1006 by snapping knob184 s onto port 1006. It is envisioned, however, that first sealassembly 1012 may be connected to port 1006 by any suitable means. Whenfirst seal assembly 1012 is assembled, instrument seal 1082 is locatedbetween cover 1080 and knob 1084. As seen in FIG. 26, instrument seal1082 includes a ring 1098 protruding distally therefrom. Ring 1098presses instrument seal against a proximal wall 1200 of knob 1084. Knob1084 includes a ring 1202 protruding proximally therefrom. Ring 1202 isadapted to be received inside an annular space 1204 formed in cover1080. During assembly, ring 1202 is positioned inside annular space 1204to facilitate interconnection between cover 1080 and knob 1084.

Knob 1084 includes a longitudinal opening 1206 configured to receive asurgical instrument and at least a portion of seal cover 1086. Sealcover 1086 includes a hole 1208 adapted to receive a surgicalinstrument. During operation, seal cover 1086 helps secure duckbillvalve 1088 to first seal assembly 1012 and first tubular member 1018.Duckbill valve 1088 is partially disposed in bore 1210 of first tubularportion 1018. In operation, duckbill valve 1088 forms a fluid-tight sealaround a surgical instrument inserted therethrough and closes in theabsence of a surgical instrument extending therethrough.

As seen in FIG. 24, second tubular portion 1120 of housing 1002 hasinner surfaces 1140 forming a bore 1138. Bore 1138 extends throughsecond tubular portion 1120 and is configured to receive a portion oftubular member 1004 and a portion of second seal assembly 1014. Secondtubular portion 1120 further includes an inner thread 1144 formed abouta proximal end 1142 of inner surface 1140 Inner thread 1144 isconfigured to threadedly engage a portion of second seal assembly 1014.

Second seal assembly 1014 is substantially identical in construction andoperation as second seal assembly 1014 of access apparatus 100 and thuswill not be described in further detail herein. Like ports of secondseal assembly 1014 will be identified with like reference characters assecond seal assembly 114.

As seen in FIGS. 24 and 26, third tubular portion 1122 of housing 1002defines a bore 1214 dimensioned to receive a surgical instrument. Bore1214 is disposed in fluid communication with third port 1110. Third sealassembly 1016 covers third port 1110 and includes cap 1216, aninstrument seal 218, and a duckbill valve 1220. Cap 1216 has a hole 1222extending therethrough. Hole 1222 is dimensioned to receive a surgicalinstrument and leads to bore 1214 of third tubular portion 1122.Instrument seal 1218 is secured between cap 1216 and duckbill valve 1222and defines an opening 1224. Opening 1224 is configured to receive asurgical instrument. In use, instrument seal 1218 forms a fluid-tightseal around a surgical instrument inserted through opening 1224.Duckbill valve 1220 is adapted to form a fluid-tight seal around asurgical instrument inserted therethrough and close in the absence of asurgical instrument.

As seen in FIGS. 24-26, tubular member 1004 has a proximal portion 1230and a distal portion 1232. Proximal portion 1230 is positioned insidesecond tubular portion 1120 of housing 1002. In addition, tubular member1004 includes a dividing wall 1246 extending therethrough. In oneembodiment, dividing wall 1246 has a substantially S-shaped transversecross-sectional profile. It is contemplated that dividing wall 1246 mayhave a sinusoidal, zig-zag, C-shaped, triangular, straight, diagonal orany other suitable transverse cross-sectional profile. In an embodiment,dividing wall 1246 is made of a flexible and/or resilient material.Dividing wall 1246 divides the inner cavity of tubular member 1004 intofirst and second passageways 1276, 1278, as depicted in FIG. 28.

As seen in FIGS. 24 and 26, a sleeve 1248 is partially poisoned withinproximal portion 1230 of tubular member 1004. As seen in FIG. 26,another portion of sleeve 1248 is disposed inside bore 1138 of firsttubular portion 1120. Sleeve 1248 facilitates interconnection betweentubular member 1004 and housing 1002.

As shown in FIGS. 24 and 26, tubular member 1004 further includes alateral aperture 1240 for establishing fluid communication between bore1210 of first tubular portion 1210 and passageway 1276 of tubular member1004. In addition, tubular member 1004 includes another lateral aperture1242 for establishing fluid communication between bore 1214 of thirdtubular portion 1122 and passageway 1275 of tubular member 1004. Lateralaperture 1242 is disposed in diametrically opposed relation to lateralaperture 1240.

As shown in FIGS. 24 and 26, access apparatus 1000 also includes a pairof fittings 1290, 1292 each adapted to partially cover a lateralaperture 1240, 1242. Fitting 1290 is positioned between housing 1002 andtubular member 1004 and helps secure tubular member 1004 to housing1002. Moreover, fitting 1290 defines a hole 1294 aligned with lateralaperture 1240. Fitting 1292 is also disposed between housing 1002 andtubular member 1004 and aids in securing tubular member 1004 to housing1002. Further, fitting 1292 includes a hole 1296 aligned with lateralaperture 1242 of tubular member 1004.

As discussed above, at least a portion of tubular member 1004 is made ofa flexible and/or resilient material such as, for example an elastomer,stainless steel wire, shape-memory alloys, polycarbonate, etc. In theembodiment depicted in FIGS. 26 and 27, tubular member 1004 includes oneor more strands 1298 embedded in or connected to a portion thereof.Strands 1298 are made of a flexible and/or resilient material. As seenin FIG. 26, strands 1298 surround a portion of tubular member 1004. Inone embodiment, strands 1295 are made of a resilient material that helpsmaintain tubular 1004 in a straight position or in a bent position afterbeing manually bent by the user.

In operation, a user inserts access apparatus 1000 into a patientthrough a body lumen or via an incision. Then, the user advances accessapparatus 1000 toward the target body cavity. Optionally, the userinsufflates the target body cavity with insufflation gases. Toinsufflate the target body cavity, the user fluidly connects accessapparatus 1000 to a source of insufflation gases via insufflationassembly 1024. Before, after, or during insertion of access apparatus1000, the user may bend tubular member 1004 manually to reach the targetbody cavity. Next, the user activates the source of insufflation gasesto expand the body cavity. The user may then introduce one or moresurgical instruments through first, second, and/or third seal assemblies1012, 1014, 1016.

It will be understood that various modifications can be made to theembodiments disclosed herein. For example, tubular members 1004 ofvarious sizes may be connected to housing 1004. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of embodiments. Those skilled in the art will envisionother modifications within the scope and spirit of the presentdisclosure.

1. A surgical access apparatus for providing access inside a body,comprising: a housing having a first port; a tubular member extendingdistally from the housing and defining a longitudinal axis therealong,wherein the tubular member includes a lumen extending therethrough; adividing wall positioned along the lumen of the tubular member, thedividing wall having a substantially S-shaped transverse cross-sectionalprofile, wherein the dividing wall divides the lumen into first andsecond passageways, wherein each of the first and second passageways isadapted to receive a surgical instrument, and wherein the dividing wallis adapted to deflect to accommodate a surgical instrument, through oneof the first passage and the second passage, having a diametersubstantially equal to a diameter of the lumen.
 2. The access apparatusaccording to claim 1, wherein the tubular member is made of a one ofrigid material and a flexible material
 3. The access apparatus accordingto claim 1, wherein the housing includes a first tubular portiondefining an axis that is at an oblique angle relative to thelongitudinal axis of the tubular member.
 4. The access apparatusaccording to claim 3, wherein the first tubular portion of the housingincludes a bore disposed in fluid communication with the first port. 5.The access apparatus according to claim 1, wherein the housing includesa second port and a third port, each of the second and third ports beingadapted to receive a surgical instrument.
 6. The access apparatusaccording to claim 5, wherein the housing includes a second tubularportion having a bore, the bore being disposed in communication with thesecond port and the second passageway.
 7. The access apparatus accordingto claim 6, wherein the second tubular portion of the housing defines anaxis that is oriented substantially parallel to the longitudinal axis ofthe tubular member.
 8. The access apparatus according to claim 1,wherein the dividing wall is made of at least one of a flexible and aresilient material.
 9. The access apparatus according to claim 1,wherein each passage defined by the dividing wall defines a transversecross-sectional area that is substantially equal to ½ a transversecross-sectional area of the lumen of the tubular member.
 10. The accessapparatus according to claim 1, further including a first seal assemblycovering the first port of the housing and defining a first passagedisposed in communication with the first passageway defined by thedividing wall, wherein the first seal assembly is adapted to form a sealaround the surgical instrument inserted through the first passage of thefirst seal assembly.
 11. The access apparatus according to claim 1,wherein the tubular member is transitionable between a substantiallylinear position and a bent position.
 12. The access apparatus accordingto claim 11, wherein the tubular member includes a plurality of strandsdisposed thereon, the plurality of strands configured to maintain thetubular member in the substantially linear position or the bent positionwhen the tubular member is transitioned to the substantially linearposition and bent position respectively.
 13. The access apparatusaccording to claim 12, wherein the plurality of strands arelongitudinally spaced apart relative to the longitudinal axis of thetubular member.
 14. The access apparatus according to claim 12, whereinthe plurality of strands are made of at least one of a flexible and aresilient material.
 15. The access apparatus according to claim 12,wherein each of the plurality of strands extends around a circumferenceof the tubular member.
 15. The access apparatus according to claim 12,wherein the plurality of strands are embedded in the tubular member. 16.The access apparatus according to claim 12, wherein the plurality ofstrands are attached to the tubular member.